Individual
TONIALATOYA WALLACE-ELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6201 N SUNCOAST BLVD, CRYSTAL RIVER, FL 34428-6712
(352) 795-6560
(770) 776-5966
Mailing address
PO BOX 2030, HOMOSASSA SPRINGS, FL 34447-2030
(352) 621-3100
(352) 621-3121
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
4301089191
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME101987
FL MEDICAL LICENSES
FL
Enumeration date
04/11/2008
Last updated
11/17/2017
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